| NPI | 1265520662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 75415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME82596) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2025-12-29 |